Aileen McGonigal, Chong Wong, John S Archer, Armin Nikpour, Nicholas D Lawn, Andrew Neal, Wendyl Jude D'Souza
{"title":"Stereoelectroencephalography for Epilepsy Presurgical Assessment: A Nationwide Survey of Evolution of Practice in Australia.","authors":"Aileen McGonigal, Chong Wong, John S Archer, Armin Nikpour, Nicholas D Lawn, Andrew Neal, Wendyl Jude D'Souza","doi":"10.1212/CPJ.0000000000200512","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereoelectroencephalography (SEEG) is increasingly used worldwide for epilepsy presurgical evaluation. A data-driven view of SEEG practice evolution is lacking for any world region. We aimed to perform a nationwide survey of SEEG use in Australian adult epilepsy centers. We predicted that the proportion of nonlesional MRI cases, number of electrodes, and radiofrequency thermocoagulation (RF-TC) use would increase over time.</p><p><strong>Methods: </strong>All epilepsy centers in Australia undertaking SEEG in patients older than 16 years at any time were invited to participate in a nationwide survey. Data were retrospectively and/or prospectively collected on patient demographics and SEEG exploration. Descriptive statistics were used.</p><p><strong>Results: </strong>A total of 281 SEEG explorations were performed in 8 centers from 2012 until 2023, 278 of which (99%) are reported here. A definite epileptogenic MRI lesion was present in 30.6% with no overall significant growth in the proportion of nonlesional cases (χ² [1, N = 278] = 0.067, <i>p</i> = 0.79), although this varied per center. Patients identifying as Indigenous Australians comprised 1.6% of this national SEEG survey vs an estimated national indigenous population of 3.8%. The median number of electrodes increased from 8 in 2012 to 15 in 2023. A total of 174 patients (62.6%) were offered resective surgery after SEEG. Surgery was performed with 1-year follow-up in 114, of whom 72.8% were seizure-free at the last follow-up. The presence/absence of an MRI lesion was not associated with postoperative seizure-free outcomes (χ² [1, N = 114] = 0.06, <i>p</i> = 0.80). RF-TC use differed between centers and evolved, with a crossover to the majority use of RF-TC occurring 5 years after regulatory approval.</p><p><strong>Discussion: </strong>This comprehensive nationwide and regional survey of SEEG practice comprises full ascertainment of all centers and allows analysis of changes in practice over time. Whole cohort results show a high proportion of nonlesional MRI cases achieving satisfactory surgical outcomes and evolution to increased RF-TC use. Indigenous access to SEEG seems to be lower than expected, consistent with broader health care access issues for this population group. Nationwide collaboration on SEEG data provides a basis for analysis of practice at the individual center and state and national levels to optimize health care planning and sharing of expertise.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200512"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245483/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology. Clinical practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1212/CPJ.0000000000200512","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/7 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Stereoelectroencephalography (SEEG) is increasingly used worldwide for epilepsy presurgical evaluation. A data-driven view of SEEG practice evolution is lacking for any world region. We aimed to perform a nationwide survey of SEEG use in Australian adult epilepsy centers. We predicted that the proportion of nonlesional MRI cases, number of electrodes, and radiofrequency thermocoagulation (RF-TC) use would increase over time.
Methods: All epilepsy centers in Australia undertaking SEEG in patients older than 16 years at any time were invited to participate in a nationwide survey. Data were retrospectively and/or prospectively collected on patient demographics and SEEG exploration. Descriptive statistics were used.
Results: A total of 281 SEEG explorations were performed in 8 centers from 2012 until 2023, 278 of which (99%) are reported here. A definite epileptogenic MRI lesion was present in 30.6% with no overall significant growth in the proportion of nonlesional cases (χ² [1, N = 278] = 0.067, p = 0.79), although this varied per center. Patients identifying as Indigenous Australians comprised 1.6% of this national SEEG survey vs an estimated national indigenous population of 3.8%. The median number of electrodes increased from 8 in 2012 to 15 in 2023. A total of 174 patients (62.6%) were offered resective surgery after SEEG. Surgery was performed with 1-year follow-up in 114, of whom 72.8% were seizure-free at the last follow-up. The presence/absence of an MRI lesion was not associated with postoperative seizure-free outcomes (χ² [1, N = 114] = 0.06, p = 0.80). RF-TC use differed between centers and evolved, with a crossover to the majority use of RF-TC occurring 5 years after regulatory approval.
Discussion: This comprehensive nationwide and regional survey of SEEG practice comprises full ascertainment of all centers and allows analysis of changes in practice over time. Whole cohort results show a high proportion of nonlesional MRI cases achieving satisfactory surgical outcomes and evolution to increased RF-TC use. Indigenous access to SEEG seems to be lower than expected, consistent with broader health care access issues for this population group. Nationwide collaboration on SEEG data provides a basis for analysis of practice at the individual center and state and national levels to optimize health care planning and sharing of expertise.
期刊介绍:
Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.